经单侧鼻腔-蝶窦入路切除垂体腺瘤

The trans－single nasal cavity， transsphenoidal approach to pituitary adenomas

目的 介绍经单侧鼻腔－蝶窦入路切除垂体腺瘤的手术方法和疗效。方法 1994年3月～2001年3月采用经单侧鼻腔－蝶窦入路切除垂体腺瘤812例。手术沿一侧鼻腔置牵开器抵蝶窦腹侧壁，弧形切开鼻中隔根部和蝶窦腹侧壁粘膜后翻向外侧，咬除鼻中隔根部少许骨质即进入蝶窦，随后按经蝶窦入路常规方法切除肿瘤。同时对手术技巧特别是肿瘤切除和手术定位技巧进行观察和总结。结果 所有病例手术定位准确，手术经过顺利。微腺瘤内分泌学治愈率为137158，术后影像学检查大腺瘤全切率为455601，巨大腺瘤 ≥5cm全切率为2353。无局部感染、死亡和其它严重并发症。结论 经单侧鼻腔－蝶窦入路是手术切除垂体腺瘤理想的手术入路。

Objective To report the surgical approaches,techniques and operative results of the trans－single nasal cavity transsphenoidal approach to pituitary adenomas． Method 812 cases of pituitary adenomas were removed by the trans－single nasal cavity transsphenoidal approach from March,1994 to March,2001． The operative technique,especially approach orientation were summarized． Result All operations were successful,and the sphenoidal,sella and tumor position were located precisely． 137 of 158 microadenomas were cured on endocrinological investigation． 455 of 601 microadenomas and 23 of 53 giant adenomas（≥5cm were radically resected on post－operative CT orand MRI． No post－operative death or serious complications occurs． Conclusion The trans－single nasal cavity,transsphenoidal approach is a very good approach to the removal of pituitary adenomas．